By Dr. Raman Tanwar
Chief Andrologist, Urocentre, Jyoti Hospital, Gurugram, Haryana
Malleable implants offer distinct advantages over the inflatable penile implant in terms of the lower cost, no need of manual dexterity to operate and effectiveness of insertion in special situations such as ischemic priapism and as a salvage for infected prosthesis. Besides, mechanical failures with malleable prosthesis are very rare and that makes malleable implants an affordable long term solution for Indian patients.(1)
We have five approved implants presently available in India, namely the indigenous Shah’s Implant by Surgiwear, the Tube implant by Promedon, the ZSI 100 implant by Zephyr Surgical Instruments, the Rigi10 implant by Rigicon and the latest addition being the Tactra Implant by Boston Scientific.(Figure 1) These implants have been compared in Table 1 based on the information provided by the distributors and company representatives.
One of the main issues that patients anticipate with penile prosthesis insertion is the persistent erection. Concealability is a major concern for malleable implants and many patients prefer the malleable implants with memory simply because of this reason. Even though the Indian penile implant does not have memory, 90% patients find no difficulty in concealing this implant.(2) Bending the implant side by side to each other can help patients understand the memory of malleability and choose the correct options.
One of the major challenges that penile prosthesis patients face is the lack of insurance cover. There is a huge variation in the level of support provided by medical insurance globally.(3) In such a scenario cost effectiveness of the implant plays a major role in patients’ decision making.
At this stage, there is no direct comparative study among these malleable prostheses in terms of clinical efficacy, mechanical durability or safety outcomes.(4) The implantologist should lay bare the intricacies of each implant and discuss the pros and cons of each device to empower the patient to make the correct decision.
Lastly, as doctors we need to practice ethical use of penile implant as a last resort for the management of erectile dysfunction. With great power comes great responsibility and with the power that malleable implants offer to cure erectile dysfunction, the itch to offer implant as a primary therapy to patients who consult us with trust must be controlled.
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2. Chung E. Penile prosthesis implant: scientific advances and technological innovations over the last four decades. Transl Androl Urol. 2017 Feb;6(1):37-45. doi: 10.21037/tau.2016.12.06. PMID: 28217449; PMCID: PMC5313299.
3 Akand M, Ozayar A, Yaman 0, Demirel C. Mechanical failure with malleable penile prosthesis.
Urology. 2007 Nov;70(5):1007.11-2. doi: 10.1016/j.urology.2007.08.005. PMID: 18068466.
4. Krishnappa P, Tripathi A, Shah R.Surgical outcomes and patient satisfaction with the low-cost, semi-rigid Shah penile prosthesis: a boon to the developing countries. Sex Med 2021; 9: 100399.
5. Barnard JT, Grimaud L, Yafi FA. Does Medicaid Cover Penile Prosthesis Surgery? A State-by-State Analysis. J Sex Med. 2021 Aug; 18(8): 1455-1460. doi: 10.1016/j.jsxm.2021.05.010. Epub 2021 Jul 8. PMID: 34247954.
6. Chung E, Wang J. State-of-art review of current malleable penile prosthesis devices in the commercial market. Ther Adv Urol. 2023 Jul 14;15:17562872231179008. doi: 10.1177/17562872231179008. PMID: 37465318: PMCID: PMC10350748.|